Verification of Inferior Right Hepatic Vein–Conserving Segments 7 to 8 Resection of the Liver

Abstract

This study aims to investigate the safety of inferior right hepatic vein (IRHV)-conserving surgery by comparing the surgical data and postoperative complications between IRHVconserving segments 7 to 8 (S7 to S8) resection and conventional right hemihepatectomy (RH). Five patients who underwent IRHV-conserving S7 to S8 segmentectomy between 2007 and 2011 (IRHV group) and 25 liver cancer patients who underwent RH without biliary tract reconstruction during the same period (RH group) were investigated. The surgical data, postoperative complications, and duration of hospital stay were compared. The IRHV and RH groups included 2 (40%) and 13 (52%) hepatocellular carcinoma patients, respectively. There were no significant differences in liver function before surgery between the groups. The presence of the IRHV did not adversely affect the processing of the short hepatic vein or frontal dissection of the inferior vena cava. The operative time was shorter (median, 366 minutes versus 501 minutes; P ¼ 0.0001), the postoperative bilirubin level was lower (12 mg/dL versus 1.8 mg/dL; P ¼ 0.037), and the duration of hospital stay was shorter (10 days versus 14 days; P ¼ 0.002) in the IRHV group. No significant differences were noted in the intraoperative blood loss, postoperative transaminase levels, or the incidence of severe complications (Clavien grade IIIb or higher) between the groups. IRHV-conserving resection of the liver is a safe surgical procedure that is useful in preventing postoperative elevation of bilirubin level and in shortening the duration of hospital stay. 1,2 When performing radical and safe liver resection, it is necessary to secure a sufficient surgical margin 3 and set the resection range in consideration of the residual liver volume to preserve liver function. 4,5 In order to ensure the liver volume remains sufficient to prevent postoperative liver failure, the surgical procedure is frequently selected based on evaluation of liver function through assessment of the retention of indocyanine green after 15 minutes (ICGR15 test). 6For cancer with hepatocaval confluence involving the right hepatic vein, although right hemihepatectomy [RH; resection of liver segments 5 þ 6 þ 7 þ 8 (S5þ S6 þ S7 þ S8)] or vascular reconstruction is generally selected, 7,8 liver resection conserving the caudal region of the right lobe (S5 and S6) is considered an option for patients with an inferior right hepatic vein (IRHV).9 Makuuchi et al 10 proposed 4 surgical procedures for IRHV-conserving liver resection. Various researchers have described IRHV-conserving surgery, in which they reported that the technique to expose blood vessels around the inferior vena cava is complex and may have an associated risk.11-14 However, in our experience, the blood vessels may be exposed safely-similar to the exposure applied in the series of liver mobilization techniques accompanying conventional RH-by securing a visual field in which the right wall of the inferior vena cava is observed directly by applying thoracolaparotomy. 15 In addition...

Complex resections for focal neoplasms of hepatico-caval confluence in children

“…Накоплен и опыт резекций верхних сегментов печени с печеночными венами, преимущественно ППВ без ее последующей реконструкции, в том числе при отсутствии нижней ППВ, что не сопровождалось нарушением венозного оттока от сохраняемых нижних сегментов [15,16]. [17].…”

Preserving inferior right hepatic vein enabled bisegmentectomy 7 and 8 without venous congestion: a case report

“…There were several reports on a technique to determine the liver transection line in IRHV-preserving hepatectomy. Nakayama et al decided the transection line based on the discolored congested area made by cramping the RHV and right hepatic artery [ 31 ]. Sugimachi et al also demonstrated the modified hanging maneuver with taping of the IRHV to determine the transection line between segment 6 and 7 [ 32 ].…”

Resecting liver segments VII–VIII without reconstructing the right hepatic vein

“…В представленной работе показана возможность решения такой задачи, которая периодически появляется при локализации новообразования в VII-VIII сегментах печени в непосредственной близости от ствола правой печеночной вены (ППВ) и (или) формирующих его ветвей. Обычно в подобной ситуации объем операции вынужденно расширяют до правосторонней гемигепатэктомии, реже выполняют резекцию печени и участка ствола вены с последующей реконструкцией для обеспечения адекватного венозного оттока от VI и латеральной части V сегмента [5][6][7]. Также в литературе описана возможность перевязки ППВ без реконструкции, но только при наличии короткой печеноч-ной вены диаметром >5 мм -так называемой нижней ППВ (НППВ) [8][9][10][11].…”